PB2663: MODELS FOR INDIRECT ASSESSMENT OF SOME FIBRINOLYTIC PARAMETERS IN PATIENTS WITH UNSTABLE ANGINA
Authors: Yuliya Tyravska, Victoria Sobol, Marina Sharaeva, Victor Lizogub, Olexiy Savchuk
Journal: HemaSphere (2023)

Topic: 34. Thrombosis and vascular biology - Biology & Translational Research Background: Fibrinolysis plays a crucial role in coronary artery disease, including acute coronary syndrome without ST-segment elevation, particularly unstable angina (UA). However, fibrinolytic parameters are not in the standard analysis kit. Aims: To identify principal easily accessible to the doctor indicators for indirect assessment of the concentrations of tissue plasminogen activator (tPA) and its inhibitor (plasminogen activator inhibitor type 1 – PAI-1) of a patient with UA. Methods: In this cross-sectional study, we recruited 102 patients with UA (the median age 63.5 (56.0-70.0) years, 64 males (62.70%)). Informed consent was obtained. Immediately after admission, we registered four groups of parameters: clinical (UA type (new-onset (NUA) or progressive (PUA)), anamnestic (age, sex, smoking, body mass index, family anamnesis), hemodynamic (heart rate (HR), systolic, diastolic, pulse blood pressure (SBP, DBP, PBP), double product (DP)), electrocardiographic (ST-segment depression, T-wave abnormality, left bundle branch blockage, arrhythmia, Sokolow-Lyon criteria). Besides, blood was drawn. TPA and PAI-1 concentrations were determined by enzyme-linked immunosorbent assays. We used SPSS, v.22.0, particularly Spearman and Pearson tests, and multivariable linear regression. Informed consent was obtained Results: It was revealed correlations between tPA and sex (rs=-0.336, p=0.02), smoking (rs =-0.353, p=0.01), UA type (rs =-0.858, p<0.001), HR (rp=-0.684, p<0.001), SBP (rp =-0.848, p<0.001), DBP (rp =-0.899, p<0.001), PBP (rp =-0.668, p<0.001), DP (rp =-0.823, p<0.001), ST-depression (rs =0.344, p=0.001), T-abnormality (rs =-0.497, p=0.02), as well as PAI-1 and age (rp =-0.499, p<0.001), UA type (rs =-0.627, p<0.001), SBP (rp =0.310, p=0.04), PBP (rp =0.499, p=0.03), DP (rp =0.214, p=0.04), ST-depression (rs =0.542, p<0.001), T-abnormality (rs =-0.353, p=0.02), arrhythmia (rs =0.210, p=0.03), labels in stat program: “1” – male, smoking, NUA, presence of ST-depression, T-abnormality, arrhythmia. Results of multivariable linear regression for the models of indirect assessment of observed fibrinolytic parameters are presented in Table 1 - without taking into account UA type. Table 1 - Variables dependent TAP PAI-1 independent β p VIF β p VIF Age, years - -0.048 0.75 1.734 BMI, kg/ m2 - -0.199 0.75 1.876 HR, bpm -0.325 0.014 1.318 - SBP, mm Hg -0.525 <0.001 1.318 0.469 0.003 1.000 ST-depression 0.012 0.906 1.001 -0.114 0.45 2.300 T-abnormality -0.070 0.521 1.241 -0.262 0.07 1.200 Arrhythmia -0.117 0.47 1.208 R2 adj.=51.4%, р<0.001 R2 adj.=19.9%, р=0.003 However, optimal models for indirect assessment of observed parameters include UA type (Table 2). Table 2 - Variables dependent TAP PAI-1 independent β p VIF β p VIF HR, bpm -0.183 0.016 1.318 - SBP, mm Hg -0.404 <0.001 1.337 0.596 <0.001 1.129 UA type -0.435 <0.001 1.365 0.664 <0.001 1.226 R2 adj. = 65.0%, р<0.001, R2 change = 13.8% R2 adj. = 42.7%, р<0.001,R2 change= 23.1% Summary/Conclusion: The strongest correlations were revealed between observed fibrinolytic and hemodynamic parameters. In real-life practice it is recommended to take into account age, BMI, HR, SBP, ST-depression, T-abnormality, arrhythmia in patients with UA for indirect assessment of fibrinolytic system condition. Nevertheless, UA type is a strong independent factor that specifies the fibrinolytic state of the patient. Keywords: Fibrinolysis, Inhibitor, Acute coronary syndrome, Plasminogen